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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> ita ( iw g - 5,,t' 'ft-/i <br /> PROJECT ADDRESS 7 / <br /> kav&i l a tO <br /> / T C c71 e f.d(,sy 3Z 60.i. <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> Id) S al ty t b vi i , sss..7-3 S eve I n t- c,,t.,f\ "kt-e 3 1-7-12 <br /> Contractor Mail Address City State/Zip Phone <br /> Nws u,) SDS6 :2, 196 <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> r' Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> ` 1 J4� ._ PILOPLI PERMIT <br /> SignatQire • Date f ' ( Z` I ` I <br /> REVISED 11/19/2014 <br />